Identification of Paracoccidioides brasiliensis in adrenal glands biopsies of two patients with paracoccidioidomycosis and adrenal insufficiency

Abstract

SUMMARYThe authors report two cases of adrenal insufficiency secondary to infiltration of the adrenal glands by Paracoccidioides brasiliensis. The first patient had been treated for a chronic multifocal form of paracoccidiodomycosis 11 years ago. The diagnosis of the mycosis was done simultaneous with that of the adrenal insufficiency in the second patient. In both patients the diagnosis was done by direct visualization of fungus in adrenal biopsies. They were treated with hormonal supplements and itraconazol by 12 and six months, without relapses during the follow-up period.

Un caso excepcional de paracoccidioidomicosis e histoplasmosis pulmonares de presentación concomitante

“…Sabouraud cultures maintained at 28°C for 4 weeks showed growth of P. brasiliensis and in up to 15% of cases of paracoccidioidomycosis, only 9% of such cases are symptomatic, (12) as occurred in the present case. double diffusion test, which detected antibodies against P. brasiliensis and H. capsulatum.…”

Adrenal Function Status in Patients with Paracoccidioidomycosis after Prolonged Post-Therapy Follow-Up

“…Nonetheless, this study demonstrated the presence of P. brasiliensis in one patient with symptomatic adrenal insufficiency eight years after completion of an otherwise effective therapy; this patient was included in a previous report. 17 The inclusion in this series of patients with prior use of ketoconazole, a known reversible inhibitor of 21-αhydroxylase, could have complicated the results of this study. However, none of the patients with adrenal insufficiency had previously received this azole and only one patient with previous use of this medication showed subnormal response after the administration of ACTH.…”

Tuberculosis of the Adrenal Gland: A Case Report and Review of the Literature of Infections of the Adrenal Gland

“…While the acute form usually appears as progressive lymphadenopathy, the chronic form affects the skin, lungs, mucous membranes, and the adrenal glands [33]. Adrenal insufficiency occurs in a large number of patients (2.9%–48.2%) and has even been reported as the initial presenting feature [34, 35]. Autopsy series have demonstrated adrenal involvement in 85–90% of cases [35].…”